Outcomes of Multidisciplinary and Evidence-Based Management of Chronic Limb Threatening Ischemia Patients: The Impacts of Protocol-Based Care Processes
Issued Date
2023-02-01
Resource Type
ISSN
01252208
Scopus ID
2-s2.0-85149036827
Journal Title
Journal of the Medical Association of Thailand
Volume
106
Issue
2
Start Page
154
End Page
159
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand Vol.106 No.2 (2023) , 154-159
Suggested Citation
Hahtapornsawan S., Piancharoensin R., Wanitkun N., Hongku K., Puangpunngam N. Outcomes of Multidisciplinary and Evidence-Based Management of Chronic Limb Threatening Ischemia Patients: The Impacts of Protocol-Based Care Processes. Journal of the Medical Association of Thailand Vol.106 No.2 (2023) , 154-159. 159. doi:10.35755/jmedassocthai.2023.02.13775 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82405
Title
Outcomes of Multidisciplinary and Evidence-Based Management of Chronic Limb Threatening Ischemia Patients: The Impacts of Protocol-Based Care Processes
Author's Affiliation
Other Contributor(s)
Abstract
Background: Chronic limb-threatening ischemia (CLTI) represents the late stage of atherosclerotic peripheral arterial disease (PAD). Similar to atherosclerosis in other vascular beds, it is preceded by a long-standing early disease and pre-disposing conditions. Thus, the care of this patient population is theoretically best delivered by a multidisciplinary team. The authors studied the outcomes of a multidisciplinary, well-structured, and evidence-based protocol that might influence better outcomes for CLTI patients. Materials and Methods: The present study was a retrospective study done in a single center. Between January 2018 and December 2020, data were reviewed from CLTI patients that received the multidisciplinary, well-structured, and evidence-base protocol for the treatment of CLTI. The primary outcome was the perioperative clinical outcome of the patients. The secondary outcomes were the 1-year clinical outcome and the admission cost for vascular operation. Results: Two hundred thirty CLTI cases between January 2018 and December 2020 were retrospectively reviewed. Of the 230 cases, 87.9% were elderly (older than 60-years-old) with significant comorbidities including diabetes (74.3%) and hypertension (74.8%). The protocol implementation resulted in clinical outcomes in terms of both major adverse cardiac event (MACE) and major adverse limb event (MALE) at 1.3% and 6.52%, respectively. The survival rates at 1-and 2-years post-revascularization were 84.3% and 74.1%, and the 1-year follow-up MACE and MALE were 6.08% and 12.2%, respectively. Moreover, the protocol statistically improved the quality of life as measured by EuroQoL group-5 Dimensions-5 Levels (EQ-5D-5L) utility score. The median 1-year mean EQ-5D-5Q score increased from 0.332 to 0.863. The cost of the treatments was significantly higher with the increasing severities of CLTI. Conclusion: A multidisciplinary, well-structured, and evidence-based protocol may potentially be effective in improving the quality of care among CLTI patients, both in terms of clinical outcomes and overall health status.